An HSJ investigation has found that the vast majority of independent sector treatment centres did not deliver the work contracted for in 2006-07.
Statistics obtained using the Freedom of Information Act also revealed that the number of procedures at the centres was 50,000 less than predicted by a senior Department of Health official last year.
This week the outgoing chair of a primary care trust has spoken out about the procurement process for the centres.
Zenna Atkins, who stepped down as chair of Portsmouth City PCT this week, said the hard work of PCT staff and clinicians had made the centre a success for Portsmouth residents - but they had to overcome a host of initial problems.
Portsmouth's St Mary's treatment centre was one of the lowest performers up until April 2007 but the operator and PCT have worked together to develop new services and boost uptake. Portsmouth PCT is now using its share of the services - but other PCTs, which also have a share of the contract, have struggled.
Ms Atkins said she would not have chosen the ISTC route to get a much-needed facility but 'it was the only game in town'. Problems had included:
An inexperienced national implementation team, which asked PCTs to contract for extra capacity without allowing for any start-up or lead-in periods, when units might not be operating at full volume.
PCTs struggled to accurately predict what capacity they needed for particular procedures. In Portsmouth, a major forecasting error by another PCT meant far more endoscopes than needed were included in the original contract.
Unreasonable contract inducements to the private sector.
What she describes as 'a hardcore "no" lobby from the traditional NHS hospital fraternity'.
'We have found that you have to invest in good contract management to get the best out of the service,' Ms Atkins said. The St Mary's centre is now reaching targets for cataracts and several other elective procedures - and has cut waiting times for cataracts in the area. The PCT had also been able to negotiate a new diabetic retinopathy service to use some of the unused capacity at the centre.